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冷冻消融联合卡瑞利珠单抗治疗肝细胞癌的效果及安全性分析

张长旺 武宁晗 王聪 郑峥 高思铭 邹长鹏 张素静 李娜

引用本文:
Citation:

冷冻消融联合卡瑞利珠单抗治疗肝细胞癌的效果及安全性分析

DOI: 10.12449/JCH240616
基金项目: 

河北省卫生健康委医学科学研究课题 (20210335)

伦理学声明: 本研究方案于2020年6月经由河北医科大学第一医院伦理委员会审批,批号:20200690。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:张长旺负责课题设计,资料分析,撰写论文;武宁晗负责数据收集和整理;王聪负责护理患者及部分数据收集;郑峥参与课题设计;高思铭负责患者随访;邹长鹏负责参与数据分析;张素静负责协助修改论文;李娜负责课题设计,指导撰写文章并最后定稿。
详细信息
    通信作者:

    李娜, lina19742000@sina.com (ORCID: 0009-0008-5561-900X)

Efficacy and safety of cryoablation combined with Camrelizumab monoclonal antibody in treatment of hepatocellular carcinoma

Research funding: 

Medical Scientific Research Project of Hebei Provincial Health Commission (20210335)

More Information
  • 摘要:   目的  探讨分析冷冻消融联合抑制剂卡瑞利珠单抗治疗肝细胞癌(HCC)的有效性和安全性。  方法  选取2020年6月—2023年6月河北医科大学第一医院收治的HCC患者103例为研究对象,将患者随机分为联合治疗组(53例)和对照组(50例)。对照组患者接受经皮氩氦刀冷冻消融术治疗,联合治疗组患者接受经皮氩氦刀冷冻消融术联合卡瑞利珠单抗治疗。比较两组患者近期疗效、治疗前后T淋巴细胞亚群变化、肝功能及AFP变化、随访无进展生存期及总体生存期。符合正态分布的计量资料两组间比较采用成组t检验;计数资料两组间比较采用χ2检验。Kaplan-Meier法绘制生存曲线,Log-rank检验比较两组生存时间差异。  结果  联合治疗组患者总缓解率、疾病控制率均明显高于对照组(χ2值分别为4.156、4.348,P值分别为0.042、0.037)。联合治疗组患者治疗后CD3+、CD4+T淋巴细胞百分比及CD4+/CD8+值较治疗前均明显升高(P<0.05),CD8+T淋巴细胞百分比较治疗前明显降低(P<0.05),而对照组患者治疗前、后T淋巴细胞亚群均无明显变化(P值均>0.05),且治疗后联合治疗组CD3+、CD4+T淋巴细胞百分比及CD4+/CD8+值均明显高于对照组(P值均<0.05),CD8+细胞百分比明显低于对照组(P<0.05)。两组患者治疗后ALT、AST、AFP水平较治疗前均明显降低(P值均<0.05),Alb水平较治疗前明显升高(P<0.05),且联合治疗组患者治疗后ALT、AST、AFP水平明显低于对照组(P值均<0.05),Alb水平明显高于对照组(P<0.05)。两组患者Ⅲ~Ⅳ级(中重度)不良反应发生率比较差异无统计学意义(P>0.05)。联合治疗组患者无进展生存中位时间(21.32个月 vs 15.31个月)、总体生存中位时间(28.36个月 vs 20.75个月)均明显优于对照组(χ2值分别为4.689、5.030,P值分别为0.030、0.025)。  结论  氩氦刀冷冻消融联合卡瑞利珠单抗可有效提升近期疗效,改善机体免疫功能,延长生存时间,且治疗安全性良好。

     

  • 图  1  典型病例的治疗前后CT检查结果

    注: a,冷冻消融术术前;b,冷冻消融术术中,可见冰球形成;c,冷冻消融术术后1个月复查,可见肿瘤坏死;d,冷冻消融术术后6个月复查,可见肿瘤坏死无活性。

    Figure  1.  CT examination results of a typical case before and after treatment

    图  2  两组患者进无进展生存和总体生存曲线

    Figure  2.  Progression-free survival curves and overall survival curves of two groups of patients

    表  1  两组患者一般资料比较

    Table  1.   Comparison of general data between two groups of patients

    项目 联合治疗组(n=53) 对照组(n=50) 统计值 P
    性别(例) χ2=0.172 0.679
    37 33
    16 17
    年龄(岁) 64.59±7.21 65.26±8.35 t=0.437 0.663
    肿瘤最大径(cm) 8.39±2.37 8.48±2.10 t=0.204 0.839
    Child-Pugh分级(例) χ2=0.006 0.938
    A级 41 39
    B级 12 11
    CNLC分期(例) χ2=0.329 0.566
    Ⅱa~Ⅱb期 31 32
    Ⅲa~Ⅲb期 22 18
    肿瘤个数(例) χ2=0.160 0.689
    单发 40 36
    多发 13 14
    其他综合性抗癌方案(例)
    放疗 7 9 χ2=0.397 0.529
    化疗 14 15 χ2=0.119 0.731
    TACE 7 10 χ2=0.785 0.376
    29 24 χ2=0.465 0.495
    注:TACE,经肝动脉化疗栓塞。
    下载: 导出CSV

    表  2  两组患者T淋巴细胞亚群变化

    Table  2.   Changes of T lymphocyte subsets in two groups of patients

    组别 例数 CD3+ T淋巴细胞百分比(%) CD4+ T淋巴细胞百分比(%) CD8+ T淋巴细胞百分比(%) CD4+/CD8+
    联合治疗组 53
    治疗前 41.28±4.47 23.15±2.56 29.38±2.18 0.79±0.16
    治疗后 54.92±7.251) 34.95±3.111) 23.42±3.051) 1.50±0.321)
    t 11.659 21.326 11.574 14.448
    P <0.001 <0.001 <0.001 <0.001
    对照组 50
    治疗前 40.92±4.53 22.97±2.74 30.52±2.33 0.75±0.19
    治疗后 40.85±4.11 23.41±2.93 29.74±3.42 0.78±0.22
    t 0.081 0.776 1.333 0.730
    P 0.936 0.440 0.186 0.467
    注:1)与同期对照组比较,P<0.05。
    下载: 导出CSV

    表  3  两组患者肝功能及AFP水平比较

    Table  3.   Comparison of liver function and AFP levels between the two groups of patients

    组别 例数 ALT(U/L) AST(U/L) Alb(g/L) AFP(ng/mL)
    联合治疗组 53
    治疗前 141.84±15.33 156.28±25.63 15.96±3.75 369.48±57.06
    治疗后 55.63±10.761) 67.50±13.951) 38.69±7.301) 97.68±21.781)
    t 33.510 22.149 20.164 32.398
    P <0.001 <0.001 <0.001 <0.001
    对照组 50
    治疗前 143.52±16.46 159.84±28.79 16.15±2.97 379.65±65.34
    治疗后 94.52±10.21 108.57±15.62 29.85±4.16 174.53±30.69
    t 17.888 11.068 18.952 20.092
    P <0.001 <0.001 <0.001 <0.001
    注:1)与同期对照组比较,P<0.05。
    下载: 导出CSV
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  • 收稿日期:  2023-09-12
  • 录用日期:  2023-10-27
  • 出版日期:  2024-06-25
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